Contraception Health Article

CONTRACEPTION

Contraception is the use of any of various methods to prevent pregnancy. Family planning, in contrast, involves the use of contraception or other measures to limit the number of children and plan the timing and spacing of births. Contraception has been used throughout history. Early methods, however, were ineffective (drinking potions or douching) or dangerous and not available to all people. By the middle of the twentieth century, only 13 percent of couples worldwide used effective methods of contraception. By the year 2000, UNICEF estimated that this figure had risen to 50 percent.

Contraceptive use is not equally distributed throughout the world. Most of western Europe, the United States, parts of Latin America, and Oceania demonstrate high levels of use. India, Pakistan, Nigeria, Sudan, Oman, Yemen, Haiti, Guatemala, Bolivia, and nations in sub-Sahara Africa demonstrate low contraceptive use and high fertility. In the past, family planning programs in some countries were, in effect, population control programs. They were often coercive and did not allow families choice. This is changing, as more people want to limit their family size. In some places, such as China, a strict population control policy is still in place.

In l994, the global attendees at the International Conference on Population and Development (ICPD) in Cairo, Egypt, placed family planning within a holistic context of reproductive health, and family planning is now considered to be a human right. Family planning helps save women's lives. Over 585,000 women die every year from unsafe abortion, childbirth, and pregnancy, with 90 percent of the deaths occurring in developing countries. These deaths are largely preventable; and contraception could play a role in preventing them.

Despite advances in contraceptive technologies, there is no single method that suits everyone. In some places, choice is limited and access is difficult, resulting in an unmet need for contraception (the condition of wanting to avoid or delay childbearing, but not using a contraceptive method).

One way to categorize contraceptive technologies is by the duration of protection. There are permanent, long-term, and short-term methods. In addition to these technologies, there are also behavioral methods of contraception. What follows is a list of all contraceptive technologies and behaviors, how they prevent pregnancy, their effectiveness, potential problems or side effects, and whether they also prevent reproductive tract infections (RTIs), hepatitis C, or sexual transmission of HIV (human immunodeficiency virus).

PERMANENT METHODS

The two permanent surgical methods of contraception are 99 to 99.5 percent effective. They do not prevent RTIs, or HIV transmission, and they both involve a risk of infection or bleeding. In male sterilization, or vasectomy, the vas deferens (the tubes that carry the sperm from the testicles to the penis) are blocked or cut. Female sterilization, or tubal ligation, is a surgical procedure in which a woman's fallopian tubes are cut, burnt, or blocked to prevent sperm from reaching and fertilizing the egg.

LONG-ACTING METHODS

None of the long-acting methods protect against RTIs or HIV transmission. IUDs, implants, and injections are 99 percent effective. Oral contraceptive pills are theoretically 99 percent effective, but pregnancies do occur if pills are missed or not taken on time.

IUD. An intrauterine device (IUD) is most often a nonhormonal method of contraception. The IUD is a small plastic or plastic and copper device placed inside a woman's uterus by a trained health care provider, and it protects against pregnancy for up to twelve years. The IUD may increase the risk of RTIs for women who have more than one partner. Side effects include increased cramping and bleeding during monthly periods. Some IUDs contain a hormone (progesterone) to increase their pregnancy protection while decreasing the risk of heavy bleeding. All of the other long-acting contraceptive methods are hormonal method.

Oral Contraceptive Pill. "The Pill" was introduced in the United States in the 1960s. It contains one or two hormones (either estrogen and progesterone together, or progesterone alone) that prevent ovulation and create a hostile environment for sperm. Although there was originally controversy over the health risks of the pill, it is now considered to be relatively safe for nonsmokers. In fact, it may protect against cancer of the ovaries and uterus. Side effects include nausea, breast tenderness, spotting, weight gain, mood changes, and headaches. Women who smoke should not take the pill as it may cause fatal blood clots. The pill's effectiveness is 99.5 percent if used perfectly, but 95 percent in real use.

Contraceptive Implants. Manufactured under the brand name Norplant®, contraceptive implants are silicone rods containing the hormone progesterone. Six of these matchstick-sized rods are placed under the skin of a woman's upper arm. The progesterone is released over time, and the implants remain effective for five years. While the effectiveness of implants is 99 percent, side effects include irregular monthly periods, spotting, acne, headaches, weight gain, and hair loss. Newer implants use one or two rods and may contain more than one hormone.

Hormonal Injections. Progesterone injections are given every two to three months, while those containing estrogen and progesterone are administered monthly. Injections work by stopping ovulation and making the cervical mucus hostile to sperm. Side effects include irregular periods, spotting, weight gain, headaches, depression, loss of libido, and hair loss.